- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. - Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...- Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- CenterWell (Providence, RI)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Providence, RI)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Commonwealth Care Alliance (Boston, MA)
- …dental and other vendors to assure integration, oversight, and efficiency of UM processes and functions. * Ensures compliance with all contract requirements, state ... the CMO and VPMA to develop and advance the UM program and leads and organizes the ongoing evaluation...* Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Datavant (Providence, RI)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
